Marsden Road Health Centre

Updated 9 June 2016

Marsden Road Health Centre is located in the South Shields area of Tyne and Wear. The practice provides care and treatment to 12,022 patients from the Westoe, Cauldwell, Harton, Cleadon, Marsden and Horsley Hill areas of South Shields. It is part of the NHS South Shields Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Marsden Road Health Centre, Marsden Road, South Shields, NE34 6RE.

The practice is located in purpose built public finance initiative premises in Marsden Road Health and Wellbeing Centre which opened in 2013. As well as the health centre the premises incorporates a dentist, gym, local social housing office, Horsley Hill Youth Project and community rooms used by a number of local groups for a variety of classes including dancing, fitness, football and toddler classes.

All reception and consultation rooms are fully accessible for patients with mobility issues and there are two on-site car parks adjoining the health and wellbeing centre.

The practice is open from 8am to 7pm on a Monday, Tuesday and Thursday (appointments from 8am to 6.50pm), 8am to 6pm on a Wednesday and Friday (appointments from 8am to 5.30pm) and 9am to 11am on a Saturday (appointments from 9am to 10.50am).

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited (NDUC).

Marsden Road Health Centre offers a range of services and clinic appointments including chronic disease management clinics, antenatal care, family planning, minor surgery, smoking cessation, travel vaccinations, childhood health surveillance and immunisations and weight management. The practice is a training practice and provides training to GP registrars (fully qualified doctors with experience of hospital medicine who are training to become a GP). It is also a research practice which means that the practice are actively involved in clinical research and their patients are able to participate in clinical trials should they wish to do so.

The practice consists of:

• Six GP partners (four male and two female)
• Three salaried GPs (one male and two female)
• A nurse manager and five practice nurses (all female)
• Two health care assistants (both female)
• 20 non-clinical members of staff including a managing partner, practice manager, reception manager, receptionists, clinical coders and secretaries

The area in which the practice is located is in the fourth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 78 (CCG average 77 and national average 79) and for the female population 83 (CCG average 81 and national average 83).

64.5% of the practice population were reported as having a long standing health condition (CCG average 59.6% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 51.5% of the practice population were recorded as being in paid work or full time education (CCG average 54.6% and national average 61.5%). Deprivation levels affecting children and older people were both lower than the CCG averages but higher than national averages.

Updated 9 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marsden Road Health Centre on 24 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect.
• The practice had obtained excellent National GP Patient Survey results in relation to care and treatment received and the ease of being able to get an appointment. 95% of patients described their experience of making an appointment as good compared to the CCG average of 78% and the national average of 73%.
• Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes to the way they delivered services in response to feedback. For example, they had introduced Saturday morning GP appointments.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.

We saw several areas of outstanding practice:

• The practice had effective systems in place to support patients with long term conditions. They had adopted an approach that ensured patients with long term conditions received proactive, holistic and patient centred care. In addition to the usual range of conditions for which long term condition reviews were offered the practice also offered reviews for conditions such as pre-diabetes, chronic kidney disease, rheumatoid arthritis, peripheral vascular disease and recurrent depressive disorder.
• The practice had created a process to ensure housebound patients with long term conditions were offered a fully comprehensive annual review. They had achieved this by ensuring practice health care assistants attended home visits for long term condition reviews armed with all necessary background information and diagnostic equipment to be able to carry out a fully comprehensive review. The results were then reviewed by a clinician who would subsequently contact the patient to carry out a follow up telephone review. The success of this initiative had led to it being adopted by the local CCG for use by their community nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 June 2016

The practice is rated as outstanding for the care of people with long term conditions.

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered a comorbidity review. In addition to the usual range of conditions for which long term condition reviews were offered the practice also offered reviews for conditions such as pre-diabetes, chronic kidney disease, rheumatoid arthritis, peripheral vascular disease and recurrent depressive disorder. The practice had decided to do this as they had identified that they had a high percentage of patients with these conditions who would benefit from regular review.

The practice were proactive in their treatment of diabetes and offered screening for risk, care of pre diabetes patients, condition management and insulin initiation led by a GP with a special interest in the condition. Practice staff told us that as a result of this they had low complication rates for diabetic patients and very few who had required any form of amputation. The practice had diagnosed 666 of their patients as having pre-diabetes, 450 of whom had undergone a review.

The practice also provided joint injections and were committed to managing long term musculoskeletal conditions in-house led by a GP with orthopaedic experience.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved very good outcomes in relation to the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.6% above the local CCG average and 2.6% above the national average.
• The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 3.5% above the local CCG average and 4% above the national average
• The practice had obtained 100% of the points available to them in respect of hypertension (2.6% above the local CCG average and 2.2% above the national average).
• The practice had obtained 100% of the points available to them in respect of diabetes (10.1% above the local CCG average and 10.8% above the national average).

The practice were committed to ensuring patients with multiple long term conditions had, where possible, one annual review with a clinician experienced in dealing with their most complex condition. They were using a risk categorisation system for patients with multiple long term conditions which meant that patients were categorised into a colour coded system dependent on which of their long term conditions presented the most risk. They were then asked to make an appointment for the appropriate clinic which ensured that appropriately trained staff were carrying out the review and had the equipment at hand they needed to do so. For example, patients most as risk from experiencing problems related to chronic obstructive pulmonary disease (COPD) were asked to make an appointment for the purple clinic. The practice then ensured that the purple clinic was staffed by clinical staff experienced and trained in treating COPD and that diagnostic equipment such as a spirometer (a device used to measure the volume of air inspired and expired by the lungs) was readily available.

The practice had taken steps to ensure that housebound patients were offered structured long term condition reviews to the same standard as more able patients able to attend the surgery. They had achieved this by ensuring practice health care assistants attended home visits for long term condition reviews armed with all necessary background information and diagnostic equipment to be able to carry out a fully comprehensive review. The results were then reviewed by a clinician who would subsequently contact the patient to carry out a follow up telephone review. The success of this initiative had led to it being adopted by the local CCG for use by their community nurses.

Updated 9 June 2016

The practice is rated as good for the care of families, children and young people.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 83.8% to 98.2% (compared with the CCG range of 84.9% to 99.4%). For five year olds this ranged from 86.7% to 100% (compared to CCG range of 91.5% to 100%. Systems were in place to follow up children who repeatedly failed to attend immunisation appointments and highlight concerns to the local safeguarding authority.

At 95%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the national average of 82.8%

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice offered a full range of contraceptive services, including implants, insertion of intra uterine devices and emergency contraception.

Updated 9 June 2016

The practice is rated as good for the care of older people.

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 98.9% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for pneumonia and shingles to older people which included home visits for any housebound patients considered to be at risk (at the time of our inspection practice staff told us that 78% of the practices older patient population had taken up the offer of a flu vaccination). The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care. This involved the development of emergency health care plans in conjunction with patients and their families and carers.

All local care homes in which the practice had patients had a named link GP to enable continuity of care. The practice operated a ward round approach to visiting patients in their main care home. All care home patients were offered a six monthly review.

All home visit requests were triaged within 30 minutes to ensure older people at risk of admission to hospital received the care they required as soon as possible.

The practice had undertaken a project to improve the management of their frail patients to ensure problems related to over treatment were minimised. They had reviewed the medication of relevant patients and ensured they had a comprehensive care plan in place. They had also created a frailty index and placed an alert on the computer record of their most frail patients to ensure they were prioritised as needing urgent care if they contacted the surgery.

Updated 9 June 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

The needs of the working age population, those recently retired and students had been met. The practice was open from 8am to 7pm on a Monday, Tuesday and Thursday (appointments from 8am to 6.50pm), 8am to 6pm on a Wednesday and Friday (appointments from 8am to 5.30pm) and 9am to 11am on a Saturday (appointments from 9am to 10.50am). The practice also offered urgent and pre bookable telephone consultations to aid patients who worked or were unable to physically attend the surgery. In addition, the practice allowed out of area patients who worked locally to register with them.

The practice offered minor surgery, joint injections, contraceptive services, travel health clinics, smoking cessation and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group.

The practice had worked with South Tyneside Council to provide a new health and wellbeing centre where patients and local residents could access a number of health promotion activities and support services.

Updated 9 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. At 87.6% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 2.4% above the local CCG and 3.6% above the national averages.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services. The practice had developed an effective working relationship with the local IAPT (Improving Access to Psychological Therapies) service.

The practice had recognised that that there was high levels of drug and alcohol addiction in their area and offered a drug reduction service, including methadone prescribing, in house. Some of the practice GPs had undertaken a Royal College of General Practitioners (RCGP) certificate in the management of drug misuse and had previously worked in rehabilitation facilities. Patients experiencing drug and alcohol dependency could self-refer to a drugs and alcohol counsellor who attended the practice on a regular basis.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice systematically screened for dementia and referred patients to memory clinics. Staff members, including some of the GPs had undertaken training to enable them to become a ‘Dementia Friend’. Patients with dementia, and their carers were regularly signposted to a local service for support and advice.

Updated 9 June 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were invited to attend the practice for an annual half hour long health check and were able to request longer appointments.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.

The practice pro-actively identified carers and ensured they were offered an annual flu vaccinations and signposted to appropriate advice and support. The practice had built questions designed to identify and assist carers into templates used by clinical staff, which included a carer’s strain index.

The redevelopment of the building offered opportunities for patients to access many activities, clubs and services. For example, there was a pop up café staffed by people with autism and learning difficulties. The practice had also agreed to educate and support vulnerable adults running and attending the café as part of a route to work programme, in the benefits of registering with, and using a GP service.